Fine Motor Impairment in Childhood Leukemia Survivors: Challenges and Interventions

Pediatric cancer, specifically acute lymphoblastic leukemia (ALL), poses significant challenges for children during and after treatment. While survival rates have improved dramatically over the years, many survivors face long-term consequences, including fine motor impairments following childhood leukemia. Researchers explored the prevalence, risk factors, and implications of fine motor impairment in adult survivors of childhood ALL, providing valuable insights for pediatric occupational and physical therapists.

Understanding Fine Motor Impairment

Fine motor skills involve the coordination of small muscles in movements that require precision and control. These skills are crucial for various daily activities, including:

  • Writing and drawing
  • Buttoning clothing
  • Using utensils
  • Performing tasks that require hand-eye coordination

Fine motor impairments can significantly affect a child’s ability to perform these tasks independently, impacting their self-esteem, academic performance, and social interactions.

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Prevalence of Fine Motor Impairment in Survivors of Pediatric ALL

Recent studies indicate that a considerable number of adult survivors of childhood ALL experience fine motor impairment. Among a sample of 875 survivors aged 25 and older, 33.6% exhibited fine motor impairment. This was determined through standardized tests, including:

  • Physical Performance Test (PPT): A standardized assessment that measures a person’s ability to perform tasks related to daily living, such as walking, dressing, and using hands for fine motor skills. It evaluates physical functional performance in real-world activities.
  • Grooved Peg-Board Test: A timed assessment used to measure fine motor dexterity and hand-eye coordination. It involves placing pegs into a board with keyhole-shaped slots, testing the speed and accuracy of fine motor movements.

These tests measured fine motor skills and compared the results to a control group of 460 community members. Survivors scored at or below the 10th percentile of the control group, highlighting the significant challenges they face.

Key Findings

  • Cranial Radiation Exposure: Survivors who underwent cranial radiation exhibited a higher incidence of fine motor impairment (45.8%) compared to those who did not receive this treatment (20.2%).
  • Sex Differences: Male survivors displayed a higher risk of fine motor impairment, with odds ratios indicating that male sex was a significant risk factor, regardless of exposure to cranial radiation.
  • Neuropathy Association: The presence of neuropathy, indicated by higher total neuropathy scores, correlated positively with the likelihood of fine motor impairment. A 1-point increase in the neuropathy score was associated with an 8% increase in the odds of fine motor difficulties.

Risk Factors for Fine Motor Impairment

Understanding the risk factors associated with fine motor impairment can aid therapists in identifying and supporting at-risk individuals. The following factors have been identified:

  • Cranial Radiation Exposure – Survivors who received cranial radiation are at a higher risk for fine motor impairments.
  • Sex – Males, both exposed and unexposed to cranial radiation, demonstrate higher odds of fine motor impairments.
  • Cognitive Function – Lower scores on cognitive assessments, such as the Wechsler Abbreviated Scale of Intelligence, were linked to an increased risk of neuropathy and subsequent fine motor impairments.
  • Educational Attainment – Survivors with less than a college education showed higher rates of fine motor impairment:
    • Less than high school: Odds Ratio (OR) = 2.23
    • High school diploma or GED: OR = 2.66
    • Vocational education: OR = 2.07
  • Social Independence – Fine motor impairments were also associated with lower levels of social independence: Moderately independent: OR = 1.80 Dependent: OR = 2.65

Implications for Educational Attainment and Social Independence

Fine motor impairment can have profound implications for the educational and social experiences of survivors. The following areas are particularly affected:

Educational Impact

  • Challenges in Learning: Difficulty with writing, typing, and other fine motor tasks can hinder academic performance, leading to lower educational attainment.
  • Reduced Participation: Survivors may avoid activities that require fine motor skills, limiting their engagement in classroom activities and peer interactions.

Social Independence

  • Daily Living Skills: Fine motor impairments can affect a survivor’s ability to perform self-care tasks, requiring assistance in personal care and daily living.
  • Employment Opportunities: Lower educational attainment and limited fine motor skills can restrict job opportunities, leading to decreased financial independence and overall quality of life.

Strategies for Occupational and Physical Therapists

Given the significant impact of fine motor impairments on survivors of pediatric ALL, early identification and intervention are crucial. Here are some strategies that therapists can employ:

1. Assessment

  • Conduct comprehensive assessments using standardized tests to identify fine motor impairments in survivors.
  • Evaluate cognitive function to understand its relationship with motor skills.

2. Individualized Interventions

  • Develop tailored therapy programs focusing on improving fine motor skills through targeted activities and exercises.
  • Incorporate cognitive rehabilitation strategies to address any underlying cognitive issues that may affect motor performance.

3. Education and Support

  • Educate survivors and their families about the potential impacts of fine motor impairments.
  • Provide resources and support for academic and vocational pursuits, emphasizing the importance of skills training and assistive devices when necessary.

4. Collaboration

  • Work collaboratively with schools, families, and community organizations to ensure a supportive environment for survivors.
  • Advocate for accommodations in educational settings to facilitate successful learning experiences.

Fine motor impairment is a significant concern for survivors of childhood acute lymphoblastic leukemia, affecting their educational attainment and social independence. By understanding the prevalence and risk factors associated with fine motor impairments, pediatric occupational and physical therapists can play a crucial role in supporting these individuals. Early identification, timely intervention, and ongoing support can lead to improved long-term outcomes, fostering a more independent and fulfilling life for survivors.

As practitioners, your efforts in advocating for and assisting survivors can help them navigate the challenges posed by fine motor impairments, ultimately enhancing their quality of life and opportunities for success.

REFERENCE

Mayuko Iijima, Geehong Hyun, Tara M Brinkman, Raja B Khan, Deo Kumar Srivastava, Leslie L Robison, Melissa M Hudson, Ching-Hon Pui, Kevin R Krull, Hiroto Inaba, Kirsten K Ness, Fine Motor Impairment and its Impact on Social Outcomes in Survivors of Pediatric Acute Lymphoblastic Leukemia: St Jude Lifetime Cohort Study, Physical Therapy, 2024;, pzae142, https://doi.org/10.1093/ptj/pzae142

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